Outcomes from medium term follow-up of patients with third and fourth degree perineal tears

Third and fourth degree perineal tears have a considerable bearing on a woman's future continence and quality of life. The RCOG recommends that all symptomatic women or those with abnormal anorectal manometric or endoanal ultrasonographic features should have the option of caesarean birth. We assessed the outcomes of 79 such women with regard to their symptoms, endoanal ultrasound and manometry findings at 6 months after delivery and the mode of delivery in the subsequent pregnancy. Some 85% of the patients were asymptomatic. Five patients (42%) had faecal incontinence and the scarring was the commonest finding on endoanal ultrasound, irrespective of symptoms. The anal manometry showed reduced squeeze and resting pressures in proportionately higher numbers of symptomatic patients. A total of 12 patients underwent a caesarean section in their next pregnancy. Three patients had a repeat third degree tear. Among those who failed to keep the colorectal appointment, we conducted a telephonic questionnaire and found that most women (32 out of 33) were asymptomatic and three women were reluctant to be examined by a male doctor. We recommend appropriate identification, repair, physiotherapy and multidisciplinary follow-up in these patients to improve long-term outcomes.